Describe Rocuronium in detail.

Pharmacology & Use

Rocuronium is an intermediate-acting aminosteroid non-depolarising relaxant whose distinctive feature is a rapid onset (approaching that of suxamethonium at higher doses). This makes it the principal non-depolarising alternative for rapid sequence induction in patients in whom suxamethonium is contraindicated.

Advantages & Reversal

Rocuronium causes little histamine release or cardiovascular disturbance. Crucially, it can be rapidly and completely reversed by sugammadex — even a profound block — which addresses the traditional concern that a long-acting non-depolarising agent used for RSI could not be quickly reversed if intubation failed. It is eliminated mainly by the liver (so is prolonged in hepatic impairment).

Place Alongside Suxamethonium

The emergence of rocuronium as a rapid-onset agent, coupled with sugammadex as a rapid and reliable means of reversing it, has changed the long-standing dominance of suxamethonium for rapid sequence induction: the combination reproduces the two properties — fast onset and, if needed, fast offset — that once made suxamethonium indispensable, while avoiding its hyperkalaemia, malignant-hyperthermia trigger and other hazards. Rocuronium is therefore the usual choice where suxamethonium is contraindicated, and increasingly a first choice in its own right where sugammadex is available.

Note

Its main dependence is hepatic, so its action is prolonged in significant liver disease.

Rocuronium plus sugammadex is an alternative to suxamethonium for RSI.

• Rocuronium: intermediate aminosteroid non-depolarising relaxant with a rapid onset.
• Main non-depolarising alternative for RSI when suxamethonium is contraindicated.
• Little histamine/cardiovascular effect; hepatic elimination.
• Rapidly reversed by sugammadex (even deep block) — rescues failed intubation.